Normal and Therapeutic Nutrition

Normal and Therapeutic Nutrition 3(2+1)

Lesson 25:Cirrhosis

Dietary management

1. Energy: Needs high calorie diet as the patient is emaciated. Calorie requirement is 2000-2500 k cal.
2. Proteins: Due to low serum albumin levels and damage of liver cells, high protein diet, is suggested for regeneration of liver cells.
• 1.2 g/kg body weight in the absence of hepatic coma.
• Milk protein (casein) and vegetable protein (valine) helps in encephalopathy.
3. Fat: 20g of medium chain triglycerides (C8-C10) till fatty liver decreases.
4. Carbohydrates: 60% of total calories can be supplied through carbohydrates which aid in glycogen stores.
5. Vitamins and minerals:
• In cirrhosis, the liver concentration of folate, riboflavin, nicotinamide, vitamin B12 and A are decreased.
• Supplementation of B vitamins is needed to prevent anaemia.
• Choline and methionine are helpful in fatty infiltration.
• Restriction of sodium to 400-800 mg/ day, if ascities is present.
• Restriction of fluid intake in hyponatremia (800-1000ml/day).
• Potassium salts are supplemented to prevent ascitis, oedema and hypokalemia
• Ferrous sulphate - 0.3 g tablet 3 times a day
• Folic acid - 1 mg/day
• Sip feeding is enteral feeding (tube feeding) - parenteral nutrition (through vein should not be prolonged due to risks of catheter sepsis and poor resolution of ascitis)